Author + information
- Eric Good, DO,
- Hakan Oral, MD⁎ ( and )
- Fred Morady, MD
- ↵⁎Cardiology, TC B1 140D, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0311
Our study (1) describes a simple, practical, and inexpensive method to visualize the position of the esophagus in relation to the left atrium during left atrial catheter ablation in real-time.We have the following responses to the points raised by Dr. Ren and colleagues:
1. Because the barium paste typically remains in the esophagus for >45 to 60 min, fluoroscopic imaging of the esophagus after a barium swallow is indeed real-time, and the anterior part of the esophagus is easily visualized.
2. Although there may be gaps in the continuity of mucosal staining after barium is swallowed, one can usually simply extrapolate from the more proximal to distal segments of the esophagus.
3. Although it is possible that barium swallow may facilitate esophageal peristalsis, patients swallow their own saliva during procedures performed under conscious sedation. Furthermore, as already discussed in our study (1) there was no correlation between the prevalence and extent of esophageal peristalsis and the amount of barium swallowed.
4. Aspiration has not occurred during or after barium swallow in over 500 patients who underwent left atrial catheter ablation under conscious sedation in our electrophysiology laboratory.
5. Figures 1A and 1B (1) are identical anteroposterior projections randomly chosen from many examples of esophageal migration. As seen in Figure 1 (1), there is marked migration of the esophagus. This clearly is not an illusion.
Finally, we do not dispute that intracardiac echocardiography also may be used for real-time monitoring of the esophagus. However, we find the barium swallow to be much simpler and practical than intracardiac echocardiography.
- American College of Cardiology Foundation